Overview Of Family Planning

Program in Bangladesh

Family Planning and the Sustainable Development Goals (SDGs) ?

The success of Family Planning Programme in Bangladesh

6.3

5.1

4.3

3.4 3.3 3.33

2.72.3 2.32.1 2.1 2.2 2 1.91.6 1.6

0

1

2

3

4

5

6

7

1975 1989 1991 1994 1997 2000 2004 2007 2011 2014

TFR

Wanted FR

8%

31%

40%

45%

50%54%

59%56%

61% 62%

1975 1989 1991 1994 1997 2000 2004 2007 2011 2014

4

37

4244

48 4852

54

60

45

5054

5956

61 62

75

1994 1997 2000 2004 2007 2011 2014 2022

0

10

20

30

40

50

60

70

80

1.8%

p.a.

0.6%

p.a.

2.6%

p.a.

mCPR CPR

However, CPR is stalling and will need to significantly increase to reach national target

Current User of Family Planning

8.3

.6

1.7

1.2

4.6

6.4

12.4

27

54.1

Any traditional method

IUD

Implant

Male sterilization

Female sterilization

Condoms

Injectables

Pill

Any modern method

5

Percent of currently married women 15-49

LAPM-

8.1%

Source: BDHS 2014

Source of Modern Contraceptives Supply

49.0%

4.0%

43.0%

4.0%

Public NGO

Private Medical Other Private

Trends in Source of Modern Contraceptives

6

BDHS 2014

Strengths of Bangladesh’s FP programme

1. FWA: Family Welfare Assistant, a female dedicated to community based FP information dissemination and doorstep services.

2. UH&FWC: Union Health and Family Welfare Center which is an institution for 30, 000 – 45, 000 population having female friendly service provider (FWV). This facility has an extension with an outpost called Community Clinics (CC) for every 6, 000 population.

3. PPP: Public Private Partnership where there is coordinated working relationship between public sector, NGOs and civil societies.

4. Contraceptive Security: Availability of contraceptives at all levels and strong established MIS including use of FWA register which is currently being digitalized.

5. Community engagement: Involvement of religious leaders like Imams, elected community leaders, civil society organizations etc.

6. Targeted SBCC (AV van, Street drama, local folk song, drama serial etc.)7

Other Contributing Factors

• Continuous political commitment

for the national Family Planning

programme

• Reduced child mortality

• Increasing trends of female

education

• Women empowerment

8

Trends in U5 Mortality

Key Challenges for Family Planning Program

68 66 6559

BDHS2004

BDHS2007

BDHS2011

BDHS2014

Trends in proportion of women age 20-24 who were first married by

age 18

31% of adolescents age 15-19 are already

mothers or pregnant with their first child

(BDHS 2014)

Young married females remain underserved

23

2017 17

19

15 1412

1993-1994 1999-2000 2011 2014

15-19-year-old married females

15-49-year-old married females

25

38

4751

45

5461 62

1993-1994 1999-2000

2011 2014

15-19-year-old married females

15-49-year-old married females

High Fertility Rate Among Adolescent

147 144

126118 113

1996-19971999-2000 2007 2011 2014

113

28.4

0.7

28.1

47

13.7

30.3

71

20.3

60

50

33.9

44.1

0 20 40 60 80 100 120

Bangladesh

Bhutan

DPR of Korea

India

Indonesia

Maldives

Myanmar

Nepal

Sri Lanka

Thailand

Timor-Leste

South-East Asia Region

Global

Adolescent Birth Rate

Missed opportunities for Postpartum Family Planning

And 47% of recently postpartum women are not using any family planning method.

48% of recently postpartum women (<12 month) are don’t want to have any more children.

But 92% want to wait at least 2 years

before having another child.

High Discontinuation Rate (30%)

34

25

40

06.5

17.8

26

Effective counselling can

reduce discontinuation due to

side effects and method failure

Equity

51%55% 53%54% 53%

56%

0%

10%

20%

30%

40%

50%

60%

No Education High Education Poorest Quintile Richest Quintile Rural Urban

Education Wealth Residence

mCPR (MW)comparison across key domains

Source: 2014 BDHS

BGD Population

160M

MWRA 31.6M

Rajshahi

TFR: 2.1

CPR: 61Dhaka

TFR: 2.3

CPR: 54

Sylhet

TFR: 2.9

CPR: 41

Khulna

TFR: 1.9

CPR: 56Barisal

TFR: 2.2

CPR: 55

Chittagong

TFR: 2.5

CPR: 47

Rangpur

TFR:1.9

CPR: 63

16

CPR (MN 62.4%):

19.7M

mCPR (54.1%): 17M

UMN (12%): 3.8M

Map: Distribution of MWRA by Division

• Income

• Gender

• Geographic location

• Education and skills

• Lifecycle

• Civil identity

• Disability

• Occupation

• Religion and ethnicity

• Sexual orientation and

• Shock-induced vulnerability.

Some Facts

3,800,000 Women in reproductive

age are not using any contraceptive

in Bangladesh

˃2,700,000 Unintended pregnancies

in each year

1,194,000 induced abortions were

performed in Bangladesh in 2014

18

Critical Areas to Address

Common Bottlenecks

Leadership/ Governance Policy or strategy implementation (population policy)

Political support and coordination

Health Financing Funding or budget allocation for contraceptives

Coverage of financing schemes

Health Workforce Lack of motivation of staff due to absence of career growth

Maldistribution between urban and rural

Lack of competency-based training including preservice and in-service

Essential Medical Products

and Technologies

Uninterrupted supply of all contraceptives

Contraceptive forecasting, procurement and tracking systems

Service Deliveries Urban, adolescent & youth

Local level planning for hard to reach

Week supervisory, mentoring and monitoring

Quality of services

Information System Introduce FP data into DHIS-2 platform

Data from private sector not routinely collected and reported

Data management and use (interpretation, analysis and planning?)

Community Ownership and

Partnership

Lack of male involvement in FP issues

Insufficient community-based advocacy efforts on benefits of FP

FAMILY PLANNING IS A HUMAN RIGHT

1968 Tehran Proclamation: “……... a basic human right to determine freely and responsibly the number

and the spacing of their children."